Provider Demographics
NPI:1619115201
Name:HANCZOR, BETHANY MICHELE (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:MICHELE
Last Name:HANCZOR
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MICHELE
Other - Last Name:GODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:661 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3307
Mailing Address - Country:US
Mailing Address - Phone:901-267-4008
Mailing Address - Fax:901-267-4099
Practice Address - Street 1:661 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3307
Practice Address - Country:US
Practice Address - Phone:901-267-4008
Practice Address - Fax:901-267-4099
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN4002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health